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Despite having a name that almost trivializes the mental disorder, borderline personality disorder is one of the most common and aggressive personality disorders. Medical professionals estimate that, in any given year, roughly 1.6% of the population is suffering from borderline personality disorder. That is a high enough percentage that just about everyone in the world likely knows and regularly interacts with someone suffering from this disorder.

Defining Personality Disorders

According to the International Classification of Diseases (ICD-11), a personality disorder is “an enduring, pervasive disturbance in how someone experiences and interprets themselves, the world and others…resulting in long-term, maladaptive patterns of emotional expression, cognition and behaviors that are inflexible and often severely problematic”.

Currently, the DSM-5 lists the following as clinical personality disorders: borderline, schizotypal, paranoid, schizoid, narcissistic, antisocial, histrionic, obsessive-compulsive, avoidant and dependent. Out of these 10, borderline personality disorder is the most diagnosed personality disorder, especially among women in their 20s and 30s and those with an addiction.

Alcohol & Personality Disorders

According to clinical studies, the prevalence of personality disorders with alcoholism ranges from as low as 22-40% to as high as 58-78%. The studies have focused primarily on antisocial and borderline personality disorders, however, almost the whole spectrum of personality disorders can be encountered in alcohol dependence, such as the dependent, avoidant, paranoid and others.

Relationship Between BPD and Substance Abuse

BPD-SUD comorbidity data obtained from studies published from 1987 to 1997 document the frequent co-occurrence of these diagnoses. Borderline personality disorder (BPD) and substance use disorders often co-occur. Both disorders are heritable and family studies showed that there are familial factors that increase the risk for BPD as well as substance use/abuse. ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3744119/ )

In fact, nearly 60 percent of adults with BPD will experience a substance abuse and/or behavioral disorder (gambling, eating disorder, sex addiction) at some point in their lives. As a core feature of BPD, impulsivity is considered the primary reason why so many people with borderline personality disorder become substance abusers.

Cluster C disorders were as prevalent as Cluster B disorders. SUD patients with PDs were younger at the onset of their first SUD and at admission; used more illicit drugs; had more anxiety disorders, particularly social phobia; had more severe depressive symptoms; were more distressed; and less often attended work or school.

Symptoms of Borderline Personality Disorder

Borderline personality disorder is marked by a pattern of ongoing instability in behavior, mood, and emotions. People suffering from this mental disorder often experience episodes of anger, anxiety, depression, fear, giddiness, and detachment that can last for as short as a few hours to as long as a few days. These episodes tend to spur impulsive behavior that interferes with social relationships and may cause harm to self or others.

Additionally, borderline personality disorder is usually associated with substance abuse, eating disorders, and self-harm. Recurring episodes create a mental state where the person suffering from this mental disorder either engages in that behavior to attempt to stave off their suffering or simply fails to recognize the risks and harm of such behavior, if already inclined towards such behavior in the first place. The risk of self-harm is particularly acute. Roughly 10% of people suffering from borderline personality disorder successfully commit suicide every year.

The most visible sign of BPD is a person’s inability to regulate emotions, which naturally leads to:

Severe mood swings (angry one minute, overly cheerful the next)

Impulsivity/poor decision making

Low self-esteem/fractured self-image

Manipulative behaviors

Fear of abandonment/dependency on others to satisfy their needs

Blaming others for their problems

Demanding immediate attention and gratification from others

Engaging in self-harming behavior

Moving from one unstable relationship to another

Frequently attempting suicide in a way that ensures someone will find them

The strong need to be accepted and loved by others also plays a key role in the link between addiction and BPD, since addicts tend to retain a wide circle of so-called “friends” who are also addicts. Unfortunately, these relationships are based on obtaining and using drugs only, which only serves to reinforce and perpetuate symptoms and consequences of BPD.

Diagnosis – Borderline Personality Disorder BPD

Borderline personality disorder can be diagnosed by a medical professional based on symptoms. Because the symptoms partially align with other mental disorders and because borderline personality disorder usually results in other disorders, a medical exam is often required to identify the causal relationships of any disorders from which the patient is suffering.

In general, borderline personality disorder is three times as likely to be diagnosed in women than in men. Additionally, there is a genetic component to borderline personality disorder. If a person has a relative with the disorder, they are five times as likely to suffer from it than if they don’t. Finally, borderline personality disorder usually doesn’t develop until early adulthood, which means that if similar symptoms appear before that time, it is likely some other mental disorder is at work.

What Causes Borderline Personality Disorder?

Researchers believe BPD has a genetic component due to results of longitudinal twin studies. In addition, people experiencing physical, emotional and/or sexual trauma during childhood are at high risk of suffering BPD. Electrophysiological studies further indicate that people diagnosed with borderline personality disorder have “deficits in higher order cortical inhibition” and “reduced activity in areas of the cortex” that are implicated in depression and general functional declension. Abnormalities in certain brain structures involving memory, mood regulation, decision-making and reward anticipation.

Borderline Personality Disorder Treatment

Borderline personality disorder is a bit unusual in one specific way. Unlike most other mental disorders, it rarely lasts for a lifetime. Close to half of all people with borderline personality disorder recover within approximately 10 years time and it is particularly rare among older individuals. As such, much of the treatment for borderline personality disorder simply focuses on quashing the symptoms until such time as the disorder naturally ceases to be problematic.

Therapy, both one-on-one and in groups, is the primary treatment for borderline personality disorder. Dialectical behavior therapy, in particular, is one of the most effective options for preventing patients from engaging in suicide or other types of self-harm, which is the largest threat from borderline personality disorder. Additionally, cognitive behavioral therapy has shown significant success in helping patients minimize the effects of episodes of emotional instability. While this doesn’t technically speed up recovery, it can effectively allow the patient to live a relatively normal life as episodes become milder and more sporadic.

Since most adults diagnosed with BPD have a substance abuse disorder fortified by rigidity of thought and behavior, psychologists consider BPD to be one of the most difficult disorders to treat.

In cases where an addiction intervention is necessary to prevent individuals with BPD from harming themselves via drugs, suicidal ideation or continuous encounters with law enforcement, confrontational approaches should not be used.

Instead, the Systemic Intervention Model is recommended to help those with BPD and addiction. SMI involves the interventionist and family members meeting together to discuss whether anyone is enabling the person with BPD and an addiction by providing money, food, transportation, clothes, etc. The SIM model is considered a solution-focused addiction treatment because it emphasizes rectifying co-dependent behaviors facilitating the BPD-diagnosed individual’s self-destructive lifestyle.

Finally, prescription medication, while not particularly effective at treating borderline personality disorder, can provide help with other resulting disorders and in minimizing some symptoms, like depression.

Robert M. has been in recovery since 1988. He is a sponsor and loyal member of AA. He has been working in the drug and alcohol field for nearly 20 years. During that time, he has written industry blogs and articles for a variety of industry websites including Transitions, Malibu Horizons, Behavioral Health of the Palm Beaches and Lifeskills of Boca Raton.

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